Related Experiment Video
Updated: Dec 28, 2025
Structured Approach to Colonoscopy Technique Optimization: A Single-Center Experience with Novice Endoscopists
Published on: July 11, 2025
Minimizing variance in pediatric surgical care through implementation of a perioperative colon bundle: A
Aaron J Cunningham1, Pavithra Rao2, Raga Siddharthan1
1Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
Insights
Implementing a pediatric colon bundle significantly reduced superficial surgical site infections (SSIs) and readmissions. This initiative aimed to standardize care and improve outcomes in pediatric colorectal surgery.
Area of Science:
- Pediatric Surgery
- Surgical Quality Improvement
- Infection Control
Background:
- An institutional initiative was launched to minimize variance in pediatric surgical care.
- Perioperative bundled interventions were implemented for colorectal procedures to reduce surgical site infections (SSIs).
Purpose of the Study:
- To evaluate the effectiveness of a standard pediatric perioperative colon bundle in reducing SSIs.
- To assess the impact of the bundle on patient outcomes and complications.
Main Methods:
- A retrospective cohort study was conducted at two children's hospitals.
- Data from 145 patients undergoing colorectal procedures before and after bundle implementation were analyzed.
- Statistical comparisons included Wilcoxon Rank-Sum, Chi-square, and Fisher exact tests, with multivariable logistic regression.
Main Results:
- Superficial SSIs decreased from 21% to 8% (p=0.031) and readmissions from 16% to 4% (p=0.021) post-implementation.
- No significant changes were observed in median hospital days, cost, reoperation, intraabdominal abscess, or anastomotic leak.
- Time period was not independently associated with SSIs (OR: 0.810, 95% CI: 0.576-1.140).
Conclusions:
- A standard pediatric perioperative colon bundle can effectively reduce superficial SSIs.
- Further prospective studies are needed to assess the broader impact on complications, hospital stay, and cost.
Background:
Employing an institutional initiative to minimize variance in pediatric surgical care, we implemented a set of perioperative bundled interventions for all colorectal procedures to reduce surgical site infections (SSIs).
Methods:
Implementation of a standard colon bundle at two children's hospitals began in December 2014. Subjects who underwent a colorectal procedure during the study period were analyzed. Demographics, outcomes, and complications were compared with Wilcoxon Rank-Sum, Chi-square and Fisher exact tests, as appropriate. Multivariable logistic regression was performed to assess the influence of time period (independent of protocol implementation) on the rate of subsequent infection.
Results:
One hundred and forty-five patients were identified (preprotocol=68, postprotocol= 77). Gender, diagnosis, procedure performed and wound classification were similar between groups. Superficial SSIs (21% vs. 8%, p=0.031) and readmission (16% vs. 4%, p=0.021) were significantly decreased following implementation of a colon bundle. Median hospital days, cost, reoperation, intraabdominal abscess, and anastomotic leak were unchanged before and after protocol implementation (all p > 0.05). Multivariable logistic regression found time period to be independent of SSIs (OR: 0.810, 95% CI: 0.576-1.140).
Conclusion:
Implementation of a standard pediatric perioperative colon bundle can reduce superficial SSIs. Larger prospective studies are needed to evaluate the impact of colon bundles in reducing complications, hospital stay and cost.
Level Of Evidence:
III - Retrospective cohort study.
More Related Videos
06:28E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
09:40An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Related Concept Videos
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:25Peptic Ulcer Disease V: Surgical Management and Nursing Care
Surgical Interventions for Peptic Ulcer Disease
01:26Varicose Veins II: Diagnostic Studies and Interprofessional Care